Paediatric Falls Risk Assessment & Prevention Strategy

Transcription

1 Paediatric Falls Risk Assessment & Prevention Strategy Education Module March 2012 Reviewed May 2016 Kristen Dove Donna McAnallen

2 Why Assess for Falls? Falls are: A major patient safety risk as identified by Accreditation Canada The leading cause of death among older adults The leading cause for injury admissions to Ontario Acute Care Hospitals Falls account for up to 84% of inpatient incidents Fall injuries pose a significant burden in terms of loss of life, reduced quality of life and economic cost RNAO Package_FINAL.pdf 1

3 Paediatric Falls Rates are typically less than adult rates; however, medication use, a new environment, and underlying medical conditions may increase a child s risk for falling in hospital An increasing number of procedures occur in the ambulatory areas, further increasing a patient s fall risk i.e. procedural sedation 2

4 Types of Falls Paediatric Falls are divided into 4 categories: Accidental: Environmental hazards (e.g. trips/slips); falls from bed surfaces Developmental: Infants/toddlers as they are learning to walk, pivot and run 3

5 Types of Falls cont d Anticipated Physiological: Patient s diagnosis or characteristics may predict their likelihood of falling (e.g. procedural sedation, post procedure recovery, unsteady gait) Unanticipated physiological: No obvious risk factors identified on assessment; falls related to conditions not anticipated such as first-time seizure, medication reactions 4

6 Why do Patients Fall? Combination of Factors such as: Mobility Impairment (Gait Disturbance) Generalized Weakness Poor Balance Use of Assistive Devices History of Illness Related Falls Before Admission After Admission 5

7 Why Do Patients Fall? Medications Medications including the following can increase the risk of falls: Anticonvulsants Opioids Benzodiazepines Sedatives/hypnotics 6

8 Why Do Patients Fall? Surgery/Procedural Sedation Surgery or procedural Sedation within the last 48 hours Cognition/Development Developmentally and/or cognitively delayed/impaired patients Very active, restless, or combative Clinical Judgment Clinical diagnosis or condition warrants fall prevention program 7

9 Goals of the Falls Prevention Program Decrease the incidence of falls Decrease the severity of falls Increase mobility and function Improve environmental safety Provide comprehensive assessment Enhance staff knowledge Improve Patients and Families confidence RNAO LearningPackage_FINAL.pdf 8

10 Why Implement Falls Risk Reduction Strategies? Falls Risk Assessment & Intervention Identification of risk prone children in a proactive manner to reduce the risk and number of falls Falls Risk Assessment is Consistent with: The RNAO Best Practice Guidelines Organizational and Accreditation requirements and practices 9

11 Who Assesses for Falls Risk? Initial assessments and reassessments for each admitted patient will be the responsibility of the clinical nurse Includes all B6 and PMDU treatment/one Day Stay patients Reassessments can be made in conjunction with allied health team i.e. physiotherapists, occupational therapists Clinical nurse to ensure documentation has taken place if assessment is done in conjunction with an allied health team member 10

12 The Process Paediatric Falls Risk Assessment Score Established Universal Fall Prevention, or High Risk Fall Prevention 11

13 Assess Patient Using Paediatric Falls Risk Assessment Complete on Admission or Transfer Daily on Patient Before Noon Change in Patient Status

14 Paediatric Falls Risk Assessment Form

15 Paediatric Falls Risk Assessment Form

16 Falls Risk Assessment (front of form) Place date and time at top of column each time an assessment is done *admission, transfer, daily before noon and when patient condition changes Assess patient for each risk using scoring guide on back of form Record a number in the column for each risk * If no risk is identified, place a 0 in the column Total the score at the bottom of the column to establish the Paediatric Falls Risk Assessment Score Initial below the total score 15

17 Scoring Implications Score Less Than Two Implement Universal Fall Prevention Interventions Score Equal To or Greater Than Two Implement High Risk Fall Prevention Interventions *both are recorded on back of form 16

18 Prevention Strategies Assessment and Implementation (back of form) Place date and time at the top of the column each time an assessment/implementation of prevention strategies is completed *admission, transfer, daily before noon and when patient condition changes Check off all interventions put in place Note: all boxes for the applicable intervention category should have a mark in them (P, N/A, *, or ) Use * & DAR documentation as needed * indicates Clinical note, then can use if unchanged on next assessment Initial bottom of column 17

19 Universal Fall Prevention Interventions Paediatric Falls Risk Score Less Than 2 Active engagement of Patient and Care Giver (Family) in all Aspects of Falls Prevention Bed Rails IV pole Safety 5 point restraints in high chairs, strollers, tables Orientation to Room Recommended use of night lights in Patient rooms to decrease falls risk 18

20 Universal Fall Prevention Interventions Bed in Lowest Position unless patient directly attended, brakes on/side rails up where appropriate One side rail up for every Patient recommended Use of non-skid footwear for ambulation Request that Care Giver (Family) bring in appropriate non-skid footwear i.e. non-skid slippers or running shoes 19

21 Universal Fall Prevention Interventions Assess elimination needs; supervise as needed Call bell, personal items and walking aids within reach Environment clear (avoid unnecessary clutter) Ensure patient is appropriately secured in wheelchair/stroller/highchair/other seating equipment Ensure brakes are engaged on moveable equipment before transferring patient 20

22 Universal Fall Prevention Interventions Assess for adequate lighting (use night lights where applicable) Patient and Family education provided on Paediatric Fall Prevention Strategies and documented on Paediatric Fall Risk Assessment and Intervention Flowsheet Paediatric fall Risk Assessment & Intervention Flowsheet on chart 21

23 High Risk Fall Prevention Interventions Paediatric Falls Risk Assessment equal to or Greater than 2 Implement Universal Fall Prevention Interventions Educate Patient/Care Giver (Family) regarding Falls Prevention Interventions Document all education on Paediatric Fall Risk Assessment & Intervention Flowsheet Apply crib topper where appropriate Identify Fall Risk on Patient care board in Nurses Station Accompany Patient with Ambulation Observe Patient frequently Q1hour Patient Care Rounds as minimum 22

24 High Risk Fall Prevention Interventions cont d Keep patient room doors/bay curtains open at all times unless isolation procedures prohibit Continuous supervision while toileting Evaluate medications that increase Patient Fall Risk Move Patients closer to the Nurses station where possible when a family member is not present Consult Physiotherapy or Occupational Therapy where appropriate Provide lift transfer if appropriate Consider if constant supervision is required (Revera) 23

25 High Risk Fall Prevention Interventions cont d Assess all alternatives to using restraints (see restraint policy) CO2O&live=1 Paediatric Falls Risk Assessment & Intervention Flowsheet on chart 24

26 Patient and Family Education Infant Population considered high risk for falls Educate Parents re; Isolettes Scales Crib Toppers Crib Sides IV tubing Extra Items in Crib Co-sleeping 25

27 Patient and Family Education Actively engage patient/family in Fall Prevention Provide appropriate resources to Patient/Family on admission i.e. Patient and Family Handbook Discuss Patients Fall Risk Status with Family/Caregiver Teach re: Fall prevention strategies, e.g. Five point harnesses, non skid footwear 26

28 Additional Documentation Document Paediatric Falls Risk Assessment Score on Patients Graphic Record Document Patients Fall Risk Status on Patient Care Kardex Document all Patient or Care Giver Education/Reinforcement of teaching on the Paediatric Fall Risk Assessment and Intervention Flowsheet 27

29 Together we CAN Make a Difference For further information on preventing and reducing patient falls please visit the RNAO website pdf f-learningpackage_final.pdf Thank you Everyone! 28

30 References Hospital for Sick Children, Ambulatory Falls and Entanglement, Strangulation, Entrapment (ESE) Prevention, Toronto, Prevention of falls and fall injuries in the older adult, Toronto,